Provider Demographics
NPI:1891356853
Name:TERKELTOUB, ABIGAIL WALSER (PA-C)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:WALSER
Last Name:TERKELTOUB
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1428 LEGACY FALLS DR APT 302
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-1863
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2709 BLUE RIDGE RD STE 320
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6462
Practice Address - Country:US
Practice Address - Phone:919-876-7692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-09210363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1161932OtherNATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS
NC0010-09210OtherNORTH CAROLINA MEDICAL BOARD